Tetanus Prophylaxis for Diabetic Patient with Minor Trauma
Give a tetanus booster (Tdap preferred) immediately—this patient's last vaccination was 10 years ago, which exceeds the recommended interval for routine booster immunization. 1, 2
Wound Classification and Critical Time Intervals
Minor trauma in this asymptomatic patient would typically be classified as a clean, minor wound, which has different prophylaxis requirements than contaminated wounds:
- For clean, minor wounds: A tetanus booster is indicated if ≥10 years have elapsed since the last dose 1, 2
- For contaminated/tetanus-prone wounds: A booster is needed if ≥5 years have elapsed 1, 2
Since this patient received their last vaccination exactly 10 years ago, they meet the threshold for booster administration even with a minor, clean wound. 3
Why Tdap Over Td Alone
Tdap is strongly preferred over Td for this patient because:
- The CDC recommends Tdap as the preferred choice for persons aged ≥11 years when tetanus toxoid-containing vaccine is indicated, particularly if prior Tdap history is unknown 1, 2
- Tdap provides additional protection against pertussis in addition to tetanus and diphtheria 1
- Tdap should be administered regardless of the interval since the last tetanus or diphtheria toxoid-containing vaccine 1
Tetanus Immune Globulin (TIG) is NOT Needed
No TIG is required for this patient because:
- The patient has completed their primary vaccination series (≥3 doses) 1, 3
- TIG is only indicated for patients with <3 lifetime doses, unknown vaccination history, or severe immunocompromise with contaminated wounds 1, 2
- Even though the patient has diabetes, this alone does not warrant TIG administration in the setting of a complete vaccination history and minor trauma 1
Special Considerations for Diabetic Patients
While diabetes increases the risk of complications from tetanus infection if it were to occur, the vaccination algorithm remains the same as for non-diabetic patients with documented complete primary immunization. 4, 5
Common pitfall to avoid: Do not confuse the 10-year routine booster interval with the 5-year interval for contaminated wounds—this is the most common error in tetanus prophylaxis. 1 Since this is described as "minor trauma" in an asymptomatic patient, the 10-year interval applies.
Clinical Pearl
More frequent doses than recommended may be associated with increased incidence and severity of adverse reactions, including Arthus-type hypersensitivity reactions. 1, 3 However, at exactly 10 years since the last dose, this patient is at the appropriate interval for safe booster administration.
Answer: A (Give tetanus booster, specifically Tdap preferred)